Laserfiche WebLink
p— c° APPLICATION SITE APPROVAL <br /> y= PRIVATE RIGHT OF WAY - ANTIQUATED SUBDIVISION <br /> ' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> <FORa`P <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site (e.g. cemeteries or structures): <br /> b kv <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc. : <br /> b At -e_ <br /> Describe any on-site or off-site sources of light of glare (e.g. parkinglot lighting, or reflective materials used): <br /> AJ 6 i2sZ <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> 1 CD ✓L <br /> Describe any displacement of people that will be caused by the project (e.g. numbers of people, housing units): <br /> A/c V', -4�- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. / <br /> Le Name: L /� V�/'(- Signature: Cc Date: <br /> Signature: Date: <br /> Signature: Date: <br /> Signature: Date: <br /> Signature: Date: <br /> F:\DEVSVC\Planning Application Forms\Site Approval) Page 5 of 7 <br /> Pri—ta Rinht of W— 1RBVIs0d4-2-03 <br />